Category Archives: Health

The New Cheese: Time Off

I believe I’ve actually addressed this issue previously, but for the life of me, I cannot recall. I want to discuss for a brief span the concept of time off. 

When we talk about time off, typically we are talking about time away from the workplace. And by workplace, that means paid for employment from an external source (differentiating between caregivers and parents who work hard, but are not necessarily reimbursed by an external agent in monetary form). There are different sorts of time away from work. These can be both paid or unpaid. For some there is differentiation between vacation and sick leave, but many employers have gone to a straight paid-time-off (PTO) system where a set amount of days or hours are given dependent upon pay grade and time in grade, and those hours/days can be used for whatever purpose needed. There are a bunch of other statutes and intricacies of labor law, such as short term disability and family medical leave act (FMLA) that govern other types of issues related to time away. Different states and countries have laws and regulations that govern these workforce and labor concerns.  For the current discussion, we will not be including paid holidays, bereavement, or mandatory closures (weather, weekends, drill/military, emergencies, disaster, etc.). 

Let’s delve a bit into history. There are some who would say that things like employee paid time off, paid holidays, sick leave, etc. are a modern invention in response to concerns for workers rights and health and unions. Turns out, probably not. It seems that there is archeological evidence to show that as far back as 1500 BCE the pharaohs of Egypt provided disability or sick leave for tomb craftsmen and workers while they received state sponsored health care to get them back on their feet (ancient workman’s comp claim… who knew?!?). So, it seems that there has been an understanding for a long time that it is cheaper to take care of trained workforce and keep them healthy than to deal with constant turnover and training new replacements every time you break one. 

There are, I know, a good deal more erudite folks on the matter of labor laws than I am with my Google searches and perusal of HR Direct mandatory policy and legal documents. However, I’ve had to develop some significant upgrades to my knowledge for my own occupations and assisting both my own employees and patients to navigate their benefits and job protection. 

As I stated earlier, some organizations, states, or countries have differences between sick time and vacation. Sick leave would be paid time for the purposes of attending to health. What are the benefits? Well, you don’t have people coming into the office and bringing plague to coworkers, patients, or customers. That’s a perk. Burnout is a thing, let me tell you. Employees who do not attend mental health and revitalization are less likely to provide quality service to customers or patients. Vacation time would be paid time that can be used for anything… namely, though, vacation, right? Time to do something for leisure. Some places give the paid time off as a lump at a designated time of the year (often January 1). Others set up accrual systems so that paid time is gained through out the year in increments (often based on time in service and rank). There are still a number of organizations that have unpaid time off, and typically to have paid time of any sort, you have to be a full time employee (so, somewhere between 35-37 hours per week minimal to qualify). Many places can get by not having PTO benefit by not having full time employees. If a worker is out, they just don’t get paid. Many hospitality roles do not have a paid time off benefit. This also applies to the self-employed and entrepreneurs out there. Independent contractors, business owners, free-lancers, etc… If you don’t work, you don’t get paid. That’s just the way it goes. However, that being said, the wise and wiley among the self-employed also build this into their business plans and taxes and all that jazz… but I digress.

What about those other categories I mentioned? The short-term-disability (STD, gotta love that, but seriously that is how it is frequently listed in the policy manuals… threw me a couple of times when reading those) and the FMLA. What are those about? Well, these are two very different things. The FMLA (Family Medical Leave Act) has different pieces to the puzzle. This law protects those that qualify from losing their jobs if they are absent due to their own illness or due to mandatory care-taking duties for children, family, partner, etc. FMLA can also apply to maternity or paternity leave with some organizations who do not have such built in separately. FMLA can be all of a single block of prescribed length of time or it can be “intermittent.” We see a lot of the intermittent type with folks who may have other caretaker assistance, but will need to take time (sometimes without warning) to deal with issues related to the care of a loved one. The important part to take note of here is that FMLA does not supply income. It literally just protects the employee from getting canned due to work absence. Which brings me to the STD bit… Short term disability is the income piece. While FMLA is actually a reference to labor law and has legally regulated measure through state and federal government, STD is actually not a requirement or mandated benefit. Employers do not have to offer this. It is something that can be offered like healthcare benefits or life insurance. Sometimes, you will see it as a deduction from pay receipts. STD must also be approved. This usually requires some evidence supplied by an attending provider. If the evidence supplied through medical documentation is insufficient based on the criteria set by the governing agency of the claim, the STD will be denied, and this means that there may be no income. 

This is all a bunch of super-complicated intricately interwoven aspects of being off from a paid employment position. I am exceedingly happy to know that there are a bunch of people who have more extensive knowledge and “back-of-the-hand” understanding of these elements upon whom I can rely to help me navigate for myself, my own staff, or my patients. However, I’ve developed in the past decade or so probably enough knowledge and understanding to be exceedingly dangerous… So, here goes with an example:

Employee A (we’ll call him Bob) wants to go on a vacation with his family this summer. He earns a set amount of hours paid time off every pay period. At the first of the year, he starts banking those hours (we’ll assume he had no rollover hours from the previous year… because that just complicates things for our example). Bob wants to take the week, and his normal pay week is 40 hours. Bob earns 6 hours of PTO per pay period. He needs to work 7 pay periods to have the 40 hours. Now, some employers will allow staff to borrow against future PTO if the employee is in good standing. Again… we’ll not delve to avoid complication. The problem for Bob is that any unplanned time off needs to either dip into his PTO or potentially be unpaid if he wants to be paid for that week at Disney with the family.

Let’s say that poor Bob has an unexpected injury that resulted in a hospital stay or prolonged absence from work. Bob’s manager (or Bob himself) would contact HR to set up FMLA. The first part of that is to safeguard Bob’s job position so that he is not laid off or terminated during this recovery time. However, this does not actually solve any issues with Bob’s income. Depending on policy, Bob may be required to utilize any PTO accrued before application for STD or being eligible for same. However, some employers may allow STD to be applied without exhausting the PTO. This would, of course, be better for Bob and his family (Disney looming, remember). Depending on the medical details and information provided by Bob’s attending physicians, Bob may not meet criteria to be approved for STD. Bob then has a choice (again, depending on the policy of the organization) to take unpaid leave or exhaust his PTO. 

Now Bob’s buddy (we’ll call him Carl… I borrowed these guys from a friend, don’t judge) has a situation with a family member which requires his close attention and a good many hours of his time to arrange and manage care. Carl has obtained caregiver support through the family member’s own healthcare benefits, but that doesn’t pay him for his time. He is still often required to take the family member to appointments and be present as, perhaps, medical power of attorney. And so, Carl faces some issues. He, too, would like to have some vacation/leisure time with his family, but the frequent demands on his hours of work do not technically fall into the STD criteria. Carl applied for and was granted intermittent FMLA which allows him to take frequent absence from work without anxiety about losing his position. However, he doesn’t get paid for that time. So, Carl has to pick and choose his use of PTO accrued (which may not allow much for a planned vacay with the family) or take the time away as unpaid to save the PTO for the planned use later in the year. Depending on Carl’s employer, he may not have a choice and be forced to exhaust his PTO before taking time as unpaid. The point being, Carl will likely need to consult his own HR guru at his place of employment for guidance. 

As you can see/read/whatever, there are intricacies and specifics, and all of them are dependent upon the policy of the employer and what benefits are actually provided by the organization. There are, unfortunately, employers who are a bit dodgy and will try to get out of paying the time off benefits. However, there are a good many studies showing that the benefit to the employee is often a benefit to the company in the long term. 

And… before I wind this particular piece up, let’s talk about the new challenges of modern time away. I’ve often written about the challenges and issues with the modern technological conveniences upon the work-life balance. While technological improvements and evolutions have provided opportunity to shorten commutes to literally a few feet down the hall, it makes it a bit too convenient to access job when allegedly being away from job. It has created some interesting concerns and solutions. For instance, I have a horrible habit of calling into meetings or checking email when I am supposed to be on vacation. Part of this is my own work-life boundary issues, but also it is stress due to expected work overload when I return. Because of the fast pace of corporate environment and (let’s be honest) a little lack of boundaries on the part of the organization, emails, phone calls, projects, and such do not get put on pause while any given employee is absent. That train just keeps on rolling, and there is an anxiety that develops about being pushed out or possibly made superfluous by merely taking time off. It’s probably an unrealistic fear, but with the current job market, anxiety is there. The other part of that work-life issue is coming back to over 1000 emails and having to spend a week or more just trying to figure out what happened while you were out. I often tell peers and employees, “Do as I say, not as I do.” I’m trying to get better about staying away and delegating, but old habits die hard. And did I mention the anxiety?

Which brings up another, slightly trickier issue. What about those legal categories? Not the planned vacations or unplanned brief sick leave, but what about the STD or FMLA? These present some significant issues for telecommuter culture. With normal workplace culture, people on STD or FMLA simply do not come to work. They aren’t working because they are not there. For a telecommuter who can work from home and has access to work through technology, how does that work?!? So, that has presented some interesting issues. It might not seem like a big deal, but legally it is. If a person is on FMLA or STD but is also working? Yeah, that develops into ugly words like fraud or abuse. Anyhow, it’s difficult to police or monitor work and lack thereof when the person doesn’t actually come to an office and clock in, right? The solution to this in some companies is to shut off access. The literally turn off the ability for the employee to log into the workplace network. It solves the problem, but it adds that layer of complication and difficulty with the IT department and the employee when they return to work. Bottom line? They can’t just *poof* come back. There are forms and requests and logic to reprogram, oh my… 

In wrapping it all up and tying with a bunch of red tape, I think there is more positive to be said for allowing employees paid time off than not. I encourage my self-employed and independent contractor folks to program that into their own budgets and schedules. Physical and mental health is easier to protect than try to reclaim when overtaxed physical and psychological systems burn out. I’ll tell you all, as I tell all my staff, “The advice is good, even if I’m not terribly good at listening to it myself.” I’m a work in progress, what can I say?

I now know why my desk chair spins…

So I can chase my tail with less expenditure of energy…

I sometimes feel like I run in circles with a lot of energy going into constant activity with relatively little to show when I get to the end of the day. It really makes me question my efficacy and efficiency.  There are days when I feel like I’m one of those performers with plates spinning on the rods… running back and forth to give each one a push and spin to keep them going. What would happen if I stopped… would they all come crashing down? Shattered plates all over, right? That’s pretty much what it feels like. It’s deceptive, too, because I’m pretty sure that if I did just take a breath, take a break, and slow it down, everything would likely just keep on ticking along.

On any given week, my work calendar looks a bit like I lost a game of Tetris. (Oh yeah… that’s what the annoying music is…). Just opening my calendar program is enough to raise the blood pressure, and that is truly a bit excessive and possibly unnecessary. I recently received a request from my superiors to share my meeting calendar with full details (It was sent to all of my colleagues actually; I wasn’t singled out or anything). My first response was, “Um… why?” with a side of “Big Brother, is that you?” However, when I did step back and reread the email, I realized that perhaps it was more along the lines of leadership wanting to make sure that we aren’t being obligated to meetings that are truly just redundant or in which my participation is not necessary. There isn’t anything private or confidential on there. The only things on that calendar are meetings that have been set by said leadership. It still felt a little intrusive, I have to admit, but that was just my own knee-jerk response. I’m working on it. No one was asking to monitor my every moment. I need to let that go. Letting my boss see my calendar might mean less double and triple booking issues (which happens to me quite a lot during the day).

Recently I broke my own record by being in two conference calls at the same time with four different Webex instances, 17 instant message windows and all while trying to respond to multiple emails that continued to come into my inbox every moment. My spouse coming in the office to ask if I needed some coffee was apparently just too much, and I didn’t even hear him ask. (He’s gotten used to this over the years, and so thankfully did not take it personally.) But in truth, it was all too much. How much quality attention could I possibly be given to any of these instances with that much over extension of my various senses. It. Was. Too. Much. And I’d done it to myself, or at least allowed it.

We all do it these days. The world moves at a very fast pace. In fact, if I am very honest with myself and anyone reading, I feel anxious and antsy when I am not moving at warp speed trying to get everything done. It is sad that I cannot seem to appreciate what has been termed “down time.” I’ve lost the knack of relaxing. Maybe some of you have as well…

Even when I feel like I am coping well with my busy life, I have to take a step back and really listen to my tone of voice, my interactions with my own employees, my family, my friends, my clients… When I’m over extended my voice gets clipped. My tone gets a bit sharp, and I find myself angry when the situation really doesn’t warrant it. So, when that time comes, I need to remember that my chair spins away from the desk, and taking a break will not result in shattered plates everywhere. It’s ok for me to take my leadership’s offer to take care of me. It won’t kill me to let go and say no occasionally. It’s a work in progress, but at least my chair spins and my coffee is full.

 

 

Raindrops on cos-props, and whiskers on furries…

In the expected post-DragonCon doldrums, I am experiencing all the usual bouts of irritability, sadness, disappointment, and sticker-shock. It’s pretty much the same thing every year. I get back to the reality of people being annoyed at their jobs, annoyed with traffic, beaten-down by adulting… what? adulting is hard people!

So, paying bills post-Con is always a sobering activity (and after Con, most people need sobering). Sitting down with a budget and realizing that you may be eating a lot of beans and rice through the end of the year… Wondering if a third job might be in order… Noticing that you might have forgotten to actually mail the RSVP for niece’s wedding that was due to be mailed four days ago… what else have I forgotten in the lost space and time of DragonCon?!?

As you might imagine, it’s a tad depressing. On top of which is the overbranching theme of “You have gotten a bit old for all of this…” And that, my friends, may be the saddest and most depressing part of the post-Con funk (as opposed to  active-Con-Funk which is actually a scent that is indescribable and very recognizable… and traumatizing). It is the idea that time has passed and fandoms have changed. I saw fewer and fewer of the costumes that spoke to my heart of my favorite shows remembered. Star Wars has regained some prominence with the new movies (of which I have seen a sum total of one, and that may be all I have stomach for at this point). Star Trek has new shows which CBS is hoarding with their paid streaming contracts that prevent the viewership at large from watching en masse. Trekkies tend to be a constant population and die hard, so at least they are still representing even in this modern day.

The truth is that I felt a bit out of my element this year, like maybe these weren’t “my people” anymore. I wasn’t recognizing some of the cosplay (though still fully appreciating the beauty, creativity, and effort by so many that I saw). There were fun times, don’t get me wrong, but it just felt different than it had in years past. I still love the amazing energy that is the experience of DragonCon, but I’m starting to wonder if I’ve become more of an outsider and observer than a member of the tribe. It’s ok, I think. I’ve changed, and so has Con. And that is probably as it should be. However, I’m left, as so many are post-Con with that feeling of being bereft after so much excitement and milling throngs of people. The sights and the sounds that are part of the convention are replaced with conference calls and reports.

So, before I just completely let myself wallow in misery, I happened to catch an article on Greatist.com about how to get out of a funk. I figured, what the heck? It can’t hurt…

Turns out, it actually is a pretty good little exercise. Some may find it cheesy, but if you actually use it and approach with sincerity, it seems to work. It is a series of 5 questions and 5 “finish this sentence” that involves actually looking for positives in your life. Even in the worst circumstances, we can all find at least one thing that doesn’t completely suck. I do this with patients who struggle with depression and anxiety as well. It can be difficult to find the light when it is overshadowed with bad experiences, disappointments, or clinical depression, but for your average everyday funk mood, it can raise that bar just enough to pull you out of a complete tailspin.

Ask yourself these questions:
1. What’s the best thing that’s happened to me so far today, and what did I most appreciate about it?
2. Which household items do I most appreciate and why?
3. What do I most appreciate about my body and why?
4. What are some things that recently went right or better than expected?

Finish these sentences:
5. I’m grateful that I’m healthy enough to…
6. Though I may not be rich, I’m thankful I have enough money to…
7. I appreciate that every day I get to…
8. The best things in life are free, including…
9. I appreciate that tomorrow I’ll get to…
10. I appreciate that I had the courage to…

So… give it a try. Be honest. A lot of people might immediately go into a negative headspace and answer the questions with the idea that there is nothing good in their life. I challenge you to find even the smallest thing as a potential positive. It might get easier as you move through the list. It might even help you see other positives that you hadn’t seen previously. Hang in there folks.

With gratitude to Susie Moore (life coach for Greatest.com) and Lori Deschene author of Tiny Buddha’s Gratitude Journal: Questions, Prompts, and Coloring Pages for a Brighter, Happier Life

The year that sped… Mental Fatigue

This morning I got up… per my usual… at the usual time. It was dark out. Just last week, it wasn’t dark… was it? I could swear it was at least the faint, gray pre-dawn thing. But today… nope. Dark. Like night. Which pretty much reminded me that I meant to get so much done this summer… and didn’t.

What happens to me and my time that I fail to accomplish the goals and tasks that needed to be accomplished? And what about the things that I wanted (rather than needed) to do?

So here I am… about 2 weeks more before I am squarely in the fourth quarter of 2018 and I find that there are many things that I meant to get to… and didn’t. Many pounds I meant to shed… and… nope… those are still firmly where they were (and I think they brought friends to stay with them). The panic sets in, and not just a small modicum of guilt. Did I waste all my time? Did I procrastinate necessary chores in favor of vegetating like a lump while my brain oozed from my ears binging a series on Netflix? Am I a terrible slackard for not getting all my to-do tah-done? It’s enough to discourage, dishearten, and generally depress… BUT, I honestly just don’t have time for that right now.

Mental exhaustion is a thing. People don’t always acknowledge this. If you go out and put in 8-12 hours of manual, sweaty labor for yourself or someone else, pretty much all parties will agree that your right to exhaustion is guaranteed. “You, my friend, have put in a hard day’s labor, and the laborer is deserving of succor and rest…” Ok, seriously, if you have friends that speak like this without actually being at a Renfaire… that is awesome! The point is that while physical labor and activity are definitely not extinct in our world, it isn’t quite the common thread that it was. In days gone by the majority of the population did have manual labor as a part of their daily lives, but most people today have occupations and avocations that are less physical and more cerebral… even if menial or tedious.

We still tend to give more credence to physical cause for tiredness than mental challenges or efforts. And that just isn’t a fair assessment at all. I get patients, employees, friends, family…  saying “I don’t know why I’m so tired… I haven’t done anything,” only to follow that up with folks telling me that they have been learning a whole new process at work or have been writing a paper that will change the way we think about biometrics and human interaction with technology on a molecular level. I even catch my own inner voice chastising my lassitude when all I’ve seemingly done all day is sit at a desk in meetings.

HEY PEOPLE!!! That is work. Your brain requires energy to power it, and when it has been put to use trying to absorb new information or synthesize an innovation, it is using that energy. The result? We. Get. Tired. And now I have shades of Mel Brooks with Madeline Kahn running around in my head… probably using more of that energy.

Our brains use up a ton of energy (and Calories) every day just to keep us breathing, digesting, moving around… passive stuff that we don’t even consciously acknowledge. When we then add to it the need to process additional data and input, it is work. While it may be using the “muscle” between your ears instead of the ones attached to long bones throughout your skeleton, it is still potentially exhausting.

I guess the bottom line, upshot, in conclusion, and all that jazz that I wish to impart to anyone still reading is that brain work is still work, and your body and mind require recovery just as much as for physical effort. And for those of us that maybe didn’t get everything accomplished that we set out to do at the beginning of the summer or year, it’s ok. Set small steps, give yourself credit for the things you did do, and even small victories deserve a celebration. Take care of yourselves.

Physical Fit: The negative about body positive

What I am about to say is by no means original or earth shattering. It just isn’t. I’m not the first to notice some of the less healthy bits that have come about due to what has been dubbed the “body-positive” movement.

Now, before anyone starts in on their defense rebuttal and argument strategies (which everyone in this day and age is wont to do, because we don’t actually listen anymore… but that is a different post for another day) hear me out… or read me? Or whatever…

The movement has been called Body Positive because it was intended to promote appreciation for the natural form without being forced to the ideals of a society that appears to be entirely divorced from the reality of the human body. It was a movement to combat the push to get people to make unhealthy choices about their eating or behavior merely because their own physical appearance was outside the perceived ideals of society. It’s a great philosophy… on paper… in an ideal world. For the most part, I agree with the premise of being positive and feeling good about who you are without having to harm yourself physically trying to fit into unrealistic silhouette. I do not think that everyone should look the same or even be forced into the unnatural confines of a body that is unhealthily restricted or genetically impossible. Women (and men) have had society’s physical expectations thrust upon them since, probably, the dawn of time. The sense of what is or isn’t attractive (if we believe all those science types) should be defined by that which makes for healthiest reproduction and genetic superiority. Yes, I said that. Where it all seems to have gone a bit tits-up was when the definition of “success” was less about the superiority of physical genetics and more about Who’s Who (back when you couldn’t purchase your way into the register).

So, as a species we went from strongest, healthiest, most likely to survive to reproductive maturity… to whatever was the most popular and most in the public eye, regardless of physical health. Technically, this is probably still about what was at one point going to survive or at least make the most attempts at reproduction (popularity and financial success/stability can work their wiles on many). This resulted in some fairly ridiculous fashion trends that included emaciated appearances or even the complexion and frailty of tuberculosis. And don’t let’s get started on corsets for women and men. The human race has pursued some seriously peculiar trends. Still, times change, attractiveness and fashion changing right along with them. Eventually, the time came that people got fed up with the unrealistic and unhealthy expectations.

All of a sudden, people were encouraging young women… and men… to focus on being healthy and appreciating their body rather than adopting unhealthy practices in attempts to replicate body proportions that are frankly impossible to achieve with merely a good diet and exercise program. Many people started appreciating their own bodies and sharing that with others (thanks, social media). The Body Positive movement encouraged people of all types and shapes and sizes to appreciate what is good and healthy about their own bodies rather than being self-critical and self-loathing based on societal expectations. The movement created an upwelling of acceptance and a cheer heard from normal, average, non-supermodel bodies around the world said “Go us!”

What could possibly go wrong with that?!? Well… like any good, positive, and supportive trend, there is always the “over-do-it” principal and, of course, the backlash. Anything that humans create that is healthy will generally be taken to an inappropriate extreme and used improperly by some. And that, my friends, is pretty much what happened. For all the great job that being positive about our bodies did to combat eating disorders, body shaming, and dispelling the myths of only “thin can get in,” there were those who used those good intentions in supporting, validating, and maintain frankly unhealthy habits. Healthcare professionals were lambasted for certain recommendations for patients who could benefit from healthier lifestyles as being demeaning and “fat-shaming.” While I do not claim that all healthcare professionals are without flaw, I also believe that they try to work towards the best health outcomes of the patients in their care. Most (though definitely not all) health providers base their diagnostics and recommendations on more than general appearance or the visible expectations of society. So, when they suggest certain actions, it isn’t just because they think you look unpleasant in your clothing (or out of them). Usually, it also has something to do with lab results. Additionally, the attempts to be more positive about all body types, sizes, and shapes had the back-lash effect of what some called “skinny-shaming.” Folks who might be more in line with thinner ideals or even more on the underweight side started catching some of the negative comments and frankly critical feedback. From the days where the “chubby kid” got bullied, the shift has come to making insulting comments about people who have difficulty putting on the extra pounds. For those who might say, “Hell, I’d love to have that problem…” it can be a very serious issue that results in bone deterioration and other health concerns.

Additionally, the word “diet” became a focus for anger and people said that you cannot follow a diet and be body positive. I get where they are coming from, I think. After years of crazy crash diets and ridiculously extreme weight-loss programs that took people to levels of starvation and encouraged eating disorders, the word diet became a word that meant cutting OUT or cutting caloric content significantly. Let me say this: “Diet” refers to any program or menu of suggested eating. Diets can be constructed to gain weight. Diets can be developed to address particular health conditions. Telling someone who actually does embrace their own healthy body (whatever that body looks like) that they are not body positive because they are following a diet is as bad as those who the body positive movement originally arose to combat… and now… I need to stop that rant.

What is my point? I guess what I am trying to say is that good ideas with the best of intentions can always be taken to an unhealthy extreme or abused. That doesn’t mean we should just toss them. However, it does mean that perhaps we should take them back to the purity of the original intent. Healthy is where it is at, folks. The measure of health is not always immediately visible to the eye, and we need to remember that. We do not need to ascribe to what society says we have to look like to be accepted or feel good and confident about who we are. That doesn’t mean we have a blank check to make poor decisions about our health and ignore everything that our primary care provider (or specialist) says that might be uncomfortable to hear. Feel good about doing the things that you enjoy. Let go of the self-conscious crap that says you have to look a certain way to be happy or healthy. What works for one doesn’t work for all. Learn to love what is realistically healthy for your physical and emotional make up and work towards that goal. That is the best way to be positive.

 

Physical Fit: Of inertia, momentum, set backs, and comebacks?

Break it down for me…

Warning: This post gets serious. Just letting you know. It isn’t my usual level of humor or even snark. I am letting you know up front, but I’m keeping it real with you all and hopefully it will help someone.

I file this post under the physical fit I pitched a while back, but to be completely honest, it actually applies to everything I do. I have described myself on occasion as the all-time-champion-queen-of-the-list-makers. This pertains primarily to my habit of breaking down my days, weeks, tasks, and projects into lists of smaller pieces that I quite literally cross out or check off as I go. Why? Well, for one, my memory isn’t quite what it used to be (it happens to most of us eventually). While I can remember in the most minute detail conversations and embarrassments and general unpleasant occurrences from days gone by, if I don’t write it down, I will sometimes forgets pants… ok, slight exaggeration, but I do find that writing things down keeps me from forgetting various important tasks that I need to get done. Secondly, sometimes the impact of the things we face each day can be so overwhelming, it just seems easier to turn away and give up. If that overwhelming mountain is broken up into steps… well, more on that later.

So, why under physical fit again? Well, because a very recent conversation with a person very dear to me made me remember that we all need to feel a sense of accomplishment, and sometimes those accomplishments can be relatively modest. Additionally, we all need support, and it helps to know we aren’t alone.

Last month I hit a wall. It was a big one. Construction on said wall started early in 2017 and continued throughout the year in fits and starts. A series of unfortunate events comprised of personal injuries, financial traumas, betrayals by family and friends, injustices, general cruelty and meanness by various in society, and grief seemed to participate in a competition for what could leave the biggest dent. Mostly we just keep rolling with punches and remember that there are so many people in the world fighting bigger battles and facing worse hardships. But starting in about August the construction plan on that wall of mine must have gone into overdrive. In a horrific cascade, I found myself facing the loss of seven close friends or relatives from August through the end of the year. Some were after long struggles with illness, but others were completely unexpected and devastating in their impact.

Around about mid-December, I gave up. Seriously, that is about the only way I can describe it. I woke up and just didn’t have it in me to try any more. I picked up the bloody white towel (totally metaphorical) and hurled it into the center of the ring. I was done. I didn’t care about progress or gains or losses or getting better or worse or living or dying anymore. I quit working out. I quit minding my diet (not just the caloric intake but actual allergens… more on that later). I just couldn’t see the point.

Just to be clear, if I had not had patients, clients, etc. to see, I would not have left my house and probably would not have bathed or changed clothing… Sound familiar? If you or anyone you know has depression, it should. In speaking with the person I mentioned earlier in this post (and I hope he’s ok with me sharing even if I don’t include his name), I found just as I had heard from patients and colleagues and other friends around that same time that so many of us were hit particularly hard in 2017 and particularly in the latter half of the of the year (and continued during the first of 2018). He mentioned suicidal thoughts at certain points and feeling so low that death seemed a better option. Several other people have shared the same… including me. What we were all experiencing was pain, individualized and excruciating. Depression can be debilitating, and it can be worsened by seasonal impact of light (or lack thereof). The stigma attached often prevents those suffering from trying to get help or even support.

For the most part, all of those who shared with me their dark times and dark thoughts have made it through to this point. While not all are out of the woods, they are still fighting back, and now knowing they aren’t necessarily alone.

I still didn’t get to that physical fit part, did I? So, one of the things that exacerbated my own plummet into the pit was that I gave up one of the things that actually helped… my workouts and exercise in general. Not to mention, those allergens… told you I would come back to it. In that headlong rush into self-destruction I ate all the things. Mostly all the things that my body has already indicated it doesn’t really get along with so much. I ended up with a mouth full of sores and blisters and… you all don’t want to know the rest. So, on top of the existential pain, I had the rather debilitating physical pain that at one point did not allow me to consume much more than water. Some choices carry their own punishments, and my body decidedly wanted me to remember why I don’t eat all the things.

After a month away, I dragged myself back to the gym. It wasn’t easy. It certainly wasn’t pleasant, and I definitely had to make myself step through the door. It was almost like starting over that very first day I had the fit. It felt as if I had lost every inch of ground I had covered in that time. I felt like a failure… and I nearly ran back to my car and retreated back to my dark pit.

But I didn’t. It was embarrassing to have to start over, but I recognized that I probably needed to take it slow. So, I did. I broke it into pieces. It wasn’t about an hour or even 40 minutes. I broke it down to quite literally 5 minute increments. I can put up with anything for 5 minutes, right? And that is how I got through it. That is how I got through that first day back at the gym, and the second. We can all face the difficult for 5 minutes, can’t we? For any insurmountable, horrible obstacle that life throws… break it down. And talk to someone. Reach out to the people around you. They may be struggling, too. We can get through this, even if it is a piece at a time.

The time change brought all the boys to my yard…

And the girls… and maybe not so much my yard. Rather more like MY GYM. A week or two ago, I walked into my local repository of all things fitness, and I honestly thought I had hit a strange time vortex that transported me straight into gym-tending season. Arriving at my usual uncaffeinated and pre-dawn hour, I saw… people. Lots of them. Normally, I go to the gym at this particularly uncivil time of day not only to just have a chance of shoehorning a workout into my schedule, but also because it is the least populated time for the gym… or possibly the least populated hour during which I am vaguely conscious.

But yes… all the people were there. Not only were they there, they were milling about and generally congregating in ways that made me quite uncomfortable. Normally in the wee hours of a weekday, I’ve got the place practically to myself with perhaps one or two other regulars. We all go about our programmed routines studiously avoiding eye contact and personal interaction. On the rare occasions that we accidently make eye contact or reach for the same dumb bell, there is a curt bro-nod and polite shift while we accommodate the other and move on. Instead of my usual tribe, I beheld a gaggle of strangers. They were impeding routes and interrupting sets and sitting on the benches… Yes, sitting.

Every Smith machine and bench press was occupied by tank top clad, confused-looking individuals who were… not actually moving barbell or dumb bell… no. They were staring at their phones. The four or possibly five of us that normally wander freely among the free weights stood in paralyzed perplexity as we tried to squeeze our way into at least completing our training without unintentionally touching the crowding masses around us.

Had I gotten lost? Had I lost time… like months of it? What happened to my normally zen-like peaceful place of fitness?

Oh wait… then it dawned on me. The anachronistic practice of altering time-keeping pieces to somehow fool people into thinking that the days aren’t getting shorter had occurred. Yes, my friends, Daylight Savings, or rather the return to Standard Time, had struck again.

The practice of this clockwork tango was originally proposed back in the late 1800’s and first implemented (believe it or not) in the German Empire and Austria-Hungary back around the first World War. The United States followed along not long after, and the whole time marching on… and back… and on again has been confusing us ever since. Some countries don’t even do the whole springing forward and falling back routine anymore. Thank goodness for that little mnemonic, am I right?

Anyhow, aside from totally messing with the circadian rhythm of the demonic feline who lives with me, the putting forward or back of the clock numbers doesn’t really impact my life all that much (unless I forget to do it). However, this year it did have the added “entertainment” value of increased population at the gym that I finally realized was very likely due to a few people perhaps forgetting to set their clocks back. Well… good for them. I hope they enjoyed their day of being ahead of the game at least for that one time. Now that we’ve eased back into that Standard time… I have my bench press to myself again. Thank goodness!

Physical Fit: New programs, pain, and horror monkeys

The first conversation of a morning not so long ago went something like this…

Co-worker: I feel like six shades of horror monkey turds.
Me: Oooookay… How many shades does it actually come in?
Co-worker: Eight.
Me: Ah. In that case, you aren’t completely dead yet. Carry on… (pauses before continuing) So…out of curiosity… what are the particular characteristics that make a simian “horror” instead of the usual run-of-the-mill variety…?
Co-worker: Severity of head pressure and the color of discharge from my nose.
Me: I see. So, sinus discharge is somehow related to differentiation of primate species occurring in horror vs naturally occurring ones… fascinating.

Why am I beginning this post with the above conversation? Well, I will tell you… I think I almost grasp horror monkey “turdness”. While no discharge has made evident the particular shade, I believe that today I might have fallen somewhere upon the color wheel of that excremental descriptive. Again… why? Oh, yeah, I’m a masochist.

My friend (Yes, Tess) will often remark that life is a series of experiments. We try various things, whether socially, physically, mentally, or emotionally and evaluate the outcomes for quality. Well, I’m paraphrasing… I think… hopefully not fouling up the actual premise, but you get the general idea. We do a lot of the experimenting when we are adolescents and trying to figure out who we are as independent persons. However, the experimental nature of humanity doesn’t end with adulthood. If so, we’d never have any new ideas from anyone outside their teens. And thus, it is good we continue to explore, create, and ponder the ponderings of new ideas. Where was I going with this… oh yeah: Horror monkeys.

As my experiments documented and shared with readers (all two or three of you, my undying gratitude for your loyalty) will attest, my explorations in the realm of fitness and diet have definitely had their ups and downs. Recently, I have embarked upon a new training program. I decided it was time to up my game. I needed to face my fears and make my first forays into the dreaded free weights area of the gym where the wildlife is more competitive (and spends a good deal of time looking in mirrors… yes, I know, form… but then there are the “swelfies.” That is apparently a thing, but I digress).

For those of you who possibly engage in weight lifting and fitness yourself this may seem like a ridiculous thing to fear. Am I right? You are thinking “Really? They’re just weights.” But y’all don’t understand the level of courage it takes for me to leave the safety of the cardio and mechanical advantage machines to make a complete ass of myself trying to replicate the movements with the weenie little dumbbells that were the only ones I seemed to be able to budge. It’s humiliating to have some cute little fitness model in her designer workout garb curling 50 pound weights with ease while I look like a busted can of biscuits in my free t-shirt from the local pizza place and nearly bursting a vessel trying to curl my 15 pounds. And so… I hide in the corner where I hope I will go unnoticed and not disturb the “professionals.” It also helps that I go super early most days which avoids much of the crowd. And off I went again… It’s Friday, what can I say, I’m a bit distracted.

So, the new plan is a 9-week thing. I’m on week … 2. Yes, 2. I’ve been at it for a sum total of 9 days. Last week was mostly me very awkwardly learning the various exercises from the videos on my tablet (very helpful, by the way). I still ended up aching from the new movements and different ways that the body uses free weights as opposed to the machines. I also found out that I can’t do chin ups. I used to… I did. I remember in school doing those phys-ed assessments. I could do chin ups all day. Now? Nope. My arms just said, “Aw… that’s cute.” So, again, humiliation. I have to use that assist thing that allows you to set it for counter weight so that you are only lifting a portion of your full body mass. Regardless, I was sore… everywhere. I thought for a while that I would either have to wear the same nasty clothing for a week while I recovered or I would require assistance with my activities of daily living. I’m not going to go into details, but aching leg muscles and trying to ease down for sitting upon ANY surface… think about it. It wasn’t pretty.

However, much as my more physically proficient friends predicted, my body started recovering and the soreness faded to a dull presence that was manageable. And yet… Week 2. It all starts over again. Shocking, right? One week of working out on the new plan is not going to make a miracle of my body. It is a 9-week program. If I want any results, I’ve got to give it the full trial. This is where those monkeys come in…

Leg day… makes me want to puke. I am not joking Quite literally today, in fact, the up-chucking occurred. I have some more than rudimentary knowledge of physical ailments and how the body’s chemistry works. I expect that several factors contributed. By the time I finished my workout, I could not have appeared more drenched if someone had stuck me fully clothed into a shower. So, electrolytes and temperature. No bueno. This is why people drink those nasty tasting beverages trying to replace the salts. Lifting and cardio can also draw blood flow away from the stomach adding to that not so lovely feeling. Additionally, lifting weights and training actually does create tiny tears in the muscle tissue which then heals and grows, and that’s totally oversimplifying, but the process does dump some chemicals into the system that might contribute to the world-spinning, full-blown, ralph attack. Now, why leg day gets the full brunt more so than arm, chest, back, or abs? Possibly due to the size of the muscle groups. In fact Dr. Joel Seedman confirms this:

“Basically, your gastrointestinal system isn’t getting adequate support when your body is moving blood to where it’s needed most. Some workouts are worse than others when it comes to commanding tons of blood flow—for example, leg day can leave you more prone to nausea. ‘This is due to the size of the muscles as well as the overall volume of work that the legs are capable of handling.'” (from Alexa Tucker in Self)

So… maybe three or four shades of horror monkey excrement today… At least not the full eight. I am careful enough to keep an eye on things like heart rate and such to be sure the nausea is not a symptom of something more dangerous. So far, just a symptom of me being a leg day weenie on this new program.

All of which is to say, I’ve started this new experiment. We’ll see how it goes. If the results are positive, I’ll be sure to share it. So, stay tuned. It will also help keep me honest and sticking with it even when arm day makes my pen soooooo heavy and typing somewhat difficult. Cheers!

Happy St. Hangover’s Day…

In the post-shenanigans, early morning light, I made my way to the gym. It was slightly less populated, a concession I assume to the late night revelry of all those who like to pretend to their Irish-ness for one day of the year in America. There were, however, considerably more people than I truly expected. Maybe I shouldn’t be so judgmental or pessimistic about these things. I honestly expected the gym to be a veritable ghost town with only the staff for company, but there were sufficient numbers to make finding a parking spot a bit of a challenge… but now that I think about this, the cars in the parking lot might have been vehicles abandoned by their owners in lieu of a safer Uber or Lyft option to risking jail or death on binge-drinking extravaganza day.

I am half ashamed to admit that my own celebratory activities were quite tame in comparison to years gone by… it is perhaps my own concession (to age and responsibility). Though I did have the good fortune (granted by the fae and leprechaun greeting me at the door to the establishment chosen) to spend time with friends, family, and many faces from the past, I gave up my attempts to be cool, festive, or lively before ever the dusk had given way to the dark. I made it home still quite in possession of my senses (and sobriety) and made my normal bedtime ritual. My younger self would have shaken a mournful head (to be quickly followed with aspirin for the pain that action would likely have caused). Yet, I do not feel so disappointed. I was able to have a good time without the overindulgence and bad choices that would have resulted in feeling like poo this morning or potentially even less pleasant outcomes.

And so… I went to the gym and will now head off to work (yes, I’m working on a Saturday). Instead of tired, achy, and vaguely nauseous, I feel relieved and rather proud that I managed to have a good time spending time with the people I love without abusing my body (or liver) to the point of extended recovery necessity. We live. We learn… well, at least until the next time that temptation presents me with potential bad choices from which to learn more lessons. I hope that everyone recovers well today. Remember to stay hydrated, and that time and rest are really the only true cures for a hangover… and for those of you who indulged in copious amounts of green beverages, remember not to scream too loudly in the restroom (the tiles reverberate and your head will hurt worse). Cheers dears!

Physician heal thyself…

And nurses, counselors, therapists, caregivers, social workers, case managers, community health workers, teachers, first responders, peer outreach… in short any person who spends their time (work or volunteer) opening themselves to the experiences of others’ suffering. In a recent continuing education exercise, I was asked to examine myself for resilience and potential risk of compassion fatigue. The simple act of participating in the exercise and completing the assignments for the course reminded me of the very great risk that people in caring roles face of suffering from the “cost of caring.” Amy Cunningham speaks of this beautifully and concisely in a Ted Talk, describing what this cost can be and toll it takes (link in the credits below, totally worth the viewing).

Many of us who work and volunteer in roles of service have adopted the philosophy that self-denial in pursuit of career, advancement, and the care of others is to be admired. Self-sacrifice is applauded and rewarded. Going above and beyond is the expectation. Adding insult to the expected self-injury is that we are frequently also required to be above the consequences or be able to physic our own resulting ailments. To a certain extent, I can agree with admiring dedication and industry. A good work ethic is absolutely to be admired. However, there is a fine line between a good work ethic and good self-care. I occasionally use that line as a jump rope (more about that later). For those of you in the caring professions, and a few of you who are not,  you have likely heard the term “compassion fatigue.” You may also have heard this described as secondary traumatization or vicarious trauma. What many people think of when folks talk about stress related to caring for others is burnout. I want to tell you now, that these are different concepts, related but decidedly not the same.

As caring professionals, we frequently are exposed to the traumatic experiences and information that can be shocking, depressing, or even devastating just being exposed to it, hearing it, visualizing it, and empathizing with the victims in our care. Empathy is one of the most important tools of the caring professions, but there is a cost involved in being empathic day after day. Repeated exposure or even just one event that triggers some recognition or identification becomes a lived sensory experience that transports the care giver into the realm of the victim. Some professionals begin experiencing symptoms of traumatic stress, much like those of the people who have been involved in critical incidents or crises. Different than counter-transference where the experience mirrors or parallels experiences from their own lives or triggers emotional reactivity in the part of the caregiver because of personal history, they respond with stress related symptoms purely out of empathy for the situation of those they assist. The frequency or intensity of just experiencing the trauma through the eyes of the individual they are helping is sufficient to trigger signs and symptoms. This is compassion fatigue. It is not my intent in this post to give all the specific signs and symptoms of traumatic stress, but in broad strokes, it has physical, cognitive, behavioral, emotional, and spiritual impact. It can impact relationships. It can impact efficacy as a professional.

Ok… I hear you saying, “but that sounds a lot like burnout.” Here is the most significant difference: Victims of burnout have gotten to the point that they just want to give up. They have nothing left to give, no space to absorb. They have exhausted their energy, empathy, and passion, like a bulb that was used until failure or a battery run past minimum charge. The way most experts in this topic differentiate between compassion fatigue and burnout is that people who have gotten to the point of burnout frequently no longer want to practice their profession or calling. While compassion fatigue results in risks for the professional and their clients due to potential boundary concerns and difficulty managing the stress they experience, burnout can lead to the loss of empathy and resentment towards those for whom they once cared. Professionals and volunteers with burnout can become callous and appear uncaring or harsh. It can result in errors of omission in services rendered and potential harm to patients or clients.

The important piece of this puzzle is that neither of these conditions are unavoidable. Taking the appropriate actions in self-care, consultation, and support can provide preventative measures to avoid the pitfalls of vicarious trauma and even help bring caring professionals back from the brink of burnout.

Insight into your own needs and responses can be the best preventative measure. Watch for your own signs of drowning: Irritability, sleeplessness, dread going on shift, numbness to any and all emotional content (personal or professional), rumination and inability to let go at the end of the day, fatigue, isolation, using (or abusing) alcohol or drugs… You know your own signs best. Self-awareness is the best primary defense, but when we fail to see our own symptoms, it is good to have the buddy system. Friends, family, colleagues are often great at noticing when you are “not yourself.”

Over the years, I have gotten to be much better at spotting my own particular signs of distress (and knowing how to combat these signs). When my natural defense system is on emotional overload, I fall back on my introversion and a combination of task and avoidance oriented coping (You thought task and avoidance would be mutually exclusive, didn’t you?). When I start running a tad low, I tend to become more task-oriented, workaholic, and isolating. I avoid situations and people that require my emotional presence. I tend to shut people out if it isn’t work related, and I let things go that are my best forms of self-care: Running, gym time, sleep, meditation, and play… yes play. Adult or not, we all need recreation. It helps us rejuvenate our cognitive processes. But when I’m overdrawing my emotional and empathic accounts due to work or personal stressors, these self-care processes always seem to be the first to go. I know myself well enough (after, the unspecified number of years I will admit to being on the planet) that I recognize when things in my life have gotten out of hand and I have reached that aggregate limit. When this happens, I try to fill my time and avoid any activities that might let my mind drift to the very topics or memories that hurt… and yet theses topics and memories are likely the very ones that probably need most to be taken out, examined, and processed. With that self-awareness, I also know that timing is key. If I push myself too soon, it doesn’t serve the best purpose, but if I leave it too long, my self imposed exile becomes way to comfortable and I won’t want to rejoin the world. This is where that support network comes in handy. Friends and colleagues who know me best are also the best at dragging me back out of any caves I might crawl into and encouraging the self-care I’ve probably been neglecting.

For you, my readers, I encourage an honest self examination and evaluation. Be ruthless. Be thorough, and try to recall how you handle critical events and times of intense stress. Evaluate time and outcome. How did it work? List the coping strategies that you have in your toolbox, and objectively determine whether they are truly helpful or maybe not so much.

Prevention is a keystone to good health and good mental health. Restorative and preventative exercises can divert compassion fatigue from become burnout. It is important to get rest, exercise, nutrition, and time away from constant exposure to shared trauma and the histories that recount horrific occurrences. Most jobs and deployments have leave or paid time away. It is there for a reason. Take a break. Use that time. Most importantly, it is crucial to have appropriate training, refresher courses, supervision, and/or consultation. Carrying the burden can get extra heavy, and consultation (or supervision) provides ethical opportunities to identify and address challenging aspects of situations that may trigger stress. It is important to employ your ethical decision making model and engage with colleagues who can be objective and provide good clinical counterpoint. Professional colleagues can often provide support to each other and offer insight when we get overwhelmed in our own empathic response.

Lastly, I would encourage those of you out there caring for others to remember your own natural supports: Family and friends. We often have to be concerned with confidentiality, and we also wish to protect the ones we love from some of the things we see, hear, and experience. However, don’t shut them out. You need not share details of information gained under the cloak of privacy and confidentiality (or when the story is just too terrible), but you can share your own feelings and fears. You can explain your own reactions without having to give details of the stimuli. Stay connected to humanity, especially your own. That can give you a life jacket to prevent drowning in empathy, and regardless of the proverbial command in the title, it is completely unnecessary to heal yourself.

Amy Cunningham presents on Ted Talks, Drowning in Empathy. http://edu.ava360.com/drowning-in-empathy-the-cost-of-vicarious-trauma-amy-cunningham-tedxsanantonio_d7a4359c8.html